NPIMap

Organization Active NPI

Thedacare, Incorporated

Doing business as ThedaCare Behavioral Health

  • Counselor
  • Menasha, WI
National Provider Identifier
1306959515
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
THEDACARE, INCORPORATED
Doing business as
ThedaCare Behavioral Health
Practice address
1095 Midway Rd
Menasha, WI 54952-1115
Phone
(920) 720-2300
NPI assigned
Aug 15, 2006
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU
Clinical Neuropsychologist 103G00000X NU
Psychologist 103T00000X NU
Social Worker 104100000X NU
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

1095 Midway Rd
Menasha, WI 54952-1115

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other identifiers 5

IdentifierTypeStateIssuer
42186500MedicaidWI
42213400MedicaidWI
21277600MedicaidWI
42189600MedicaidWI
42185300MedicaidWI

Other names 1

  • ThedaCare Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, UT, WA, FL, GA, KY6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20031106000088 WI Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1,069 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20171115001174 UT Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Draper, UT; Provo, UT
O20190826001611 WA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Washougal, WA; Camas, WA
O20230412001822 FL Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dade City, FL; Weston, FL; Port St Lucie, FL; Panama City Beach, FL; Orlando, FL; North Miami, FL; Miami, FL; Hobe Sound, FL…
O20231220000457 GA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Savannah, GA; Alpharetta, GA
O20240510003231 KY Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harrodsburg, KY; Lexington, KY; Prospect, KY

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • Thedacare, Incorporated

    dba ThedaCare Physicians

    • Family Medicine Physician
    • New London, WI
    • NPI 1376656959

    O20031106000088, O20171115001174, O20190826001611, O20230412001822, O20231220000457, O20240510003231

    Same enrollment

National Provider Directory

National Provider Directory

Member organizations 14

Organizations listed as members of this organization in the National Provider Directory.

View all 14

Locations

2500 E Capitol Dr
Ste 2500
Appleton, WI 54911

2005 Midway Rd
Menasha, WI 54952
Phone (920) 380-4812

130 2nd St
Ste 197
Neenah, WI 54956
Phone (920) 729-2030

200 Theda Clark Medical Plz
Ste 240
Neenah, WI 54956
Phone (920) 725-2070

640 Deerwood Ave
Neenah, WI 54956
Phone (920) 727-8622

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Ownership & related parties

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Thedacare Medical Center - Berlin, Inc.Berlin, WI, CCN 521355 Hospital Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 521303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 52Z303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 521346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 52Z346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Regional Medical Center-Neenah IncNeenah, WI, CCN 520045 Hospital Operational/Managerial Control Jan 19, 2011
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 520160 Hospital Operational/Managerial Control Nov 22, 2010
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 521334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 52Z334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - New London, IncNew London, WI, CCN 521326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Medical Center - New London, IncNew London, WI, CCN 52Z326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 52T160 Hospital Operational/Managerial Control Jan 1, 2024
Juliette ManorBerlin, WI, CCN 525286 Skilled nursing facility Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 528614 Rural health clinic Operational/Managerial Control Jan 19, 2011
Shawano Medical Center IncClintonville, WI, CCN 528608 Rural health clinic Operational/Managerial Control Jan 19, 2011

Owned or controlled facilities with NPI records 30

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 30

Practitioners & affiliated clinicians

Practitioners 255

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 255

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1306959515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521115",
            "telephone_number": "920-720-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42186500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42213400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21277600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42189600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42185300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThedaCare Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ThedaCare Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.